Northern State University
Non-Academic Complaint Form

Directions: Please use this form for non-academic complaints. A non-academic complaint refers to a substantial complaint of a serious nature. For any matter to give rise to such a complaint there must be clear and convincing evidence, which demonstrates either arbitrary or capricious action on the part of the individual faculty, administration, or staff member or action which is oppressive, fundamentally unfair, or which exceeds the limits of academic freedom. The evidence must also establish that such action was injurious. Students who wish to appeal or grieve non-academic complaints are to follow appropriate channels of communication in seeking resolution of differences.
First and last name of person filing the complaint:
Complainant’s phone number:
Complainant’s email address:
Complainant’s local address:
Date of incident:
Time of incident:
Hour:   Minutes:  
Location of incident:
Please list the individual(s) involved, including first and last name and contact information, if known. Please note any individual(s) not affiliated with Northern State University.
Please provide a detailed and concise description of the incident/concern.
Please list first and last name and contact information for any Northern State University employee(s) with whom you have discussed this incident/concern and the outcome of those discussions.
Please describe any supporting documentation (i.e. photos, video, email, and/or other media) that you may be able to provide to Northern State University. Please note that you may be contacted to provide this supporting documentation.